Provider Demographics
NPI:1528772886
Name:BIANCONI, GRACE (PHARMD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:BIANCONI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 AUTUMN OAK CIR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1228
Mailing Address - Country:US
Mailing Address - Phone:585-739-8903
Mailing Address - Fax:
Practice Address - Street 1:300 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2913
Practice Address - Country:US
Practice Address - Phone:315-781-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist